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GAM > Pain > Flashcards

Pain Flashcards

1
Q

MCC of pain in elderly adult

A

MSK causes

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2
Q

What’t the rule for Rx acetaminophen (APAP)?

A
  • lowest effective dose and shortest possible course
  • up to 3 g/day
  • CI: severe hepatic insufficiency and renal insufficiency
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3
Q

Preferred 1st line

A
  • local corticosteroids injection

- PT/massasge

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4
Q

If you need to pick up a NSAIDs for elderly patients -

A

Naproxen

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5
Q

Common se of opioidsq

A
  • fall risk

- ppx conspitation

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6
Q

Pain Rx adjuvants

A
  • Gabapentin
  • TCAs
  • SNRI: dulexetine (cymbalta)
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7
Q

T of F: acute pain should be treated early and aggressively if potentially develop into chronic pain

A

Yes

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8
Q

What defines “chronic” in chronic pain?

A
  • Pain that persist or recurs > 3 mo
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9
Q

T of F: depression and anxiety are common comorbid sx of chronic pain

A

T

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10
Q

Chronic pain is a/w vegetative signs

A

Lassitude, trouble sleeping, decreased appetite, weight loss, decreased libido, and constipation

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11
Q

What defines nociceptive pain?

A
  • Somatic or Visceral

- a/w ongoing tissue injury

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12
Q

What defines neuropathic pain?

A
  • due to dysfunctin of PNS/CNS afferents
  • pain out of propotion to the tissue injury
  • Dysesthesia is common
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13
Q

Precaution with APAP/Tylenol/Acetaminophen use

A
  • CNS analgesic
  • no anti-inflammatory activity
  • no anti-platelet activity
  • No risk of gastric irritation
  • Max dose 650-1000 mg q6-8 hr
  • Watch for concomitant use of alcohol
  • CI in hepatic injured
  • CYP inducer increase risk of liver damage
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14
Q

Precaution with NSAIDs

A
  • Risk of ulcer/GI bleeds in 65+ population 3-4X higher
  • Concomitant use of PPI reduce above risk
  • CVD risk: naproxen best choice, avoid celebrex for increased risk of stroke/MI
  • Avoid: indomethacin: delirium, personality change in elderly
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15
Q

Opioids in the elderly

A
  • longer half life
  • increased risk of fall
  • trade off between pain control + inc physical function versus reduced cognition
  • common se: constipation and urinary retention
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16
Q

Opioids in renal insufficiency

A

Transdermal buprenorphine

17
Q

1st line of DM neuropathic pain

A

Duloxetine (Cymbalta), Venlafaxine (Effexor)

18
Q

Muscle relaxants examples?

A
  • Cyclobenzaprine

- Tizanidine

19
Q

Muscle relaxants in the elderly

A

TRY to AVOID: sedation, dizziness, anticholintergic sx, weakness -> fall, delirium, GI/GU sx

20
Q

3 types of Pain

A
  • Nociceptive
  • Neuropathic
  • Mixed
21
Q

What are Rx for neuropathic pain?

A
  • TCAs
  • SNRIs
  • anticonvulsants
  • Opioids
  • topical anesthetics
22
Q

T of F, if using non-selective NSAID or celecoxib with ASA, use a PPI or misoprostol for GI protection

A

T

23
Q

T of F: do not use ibuprofen when also using ASA for cardioprophylaxis

A

Tq

24
Q

Indications for Gabapentin (neurotin)?

A
  • renally dosed
  • post-herpetic neuralgia
  • postoperative and chronic pain
25
Q

Indication for Pregabalin (Lyrica)

A
  • Post-herpetic neuralgia
  • Diabetic peripheral neuropathy
  • Fibromyalgia
26
Q

Common se with cymbalta

A
  • nausea, dry mouth, constipation, diarrhea, urinary hesitancy
  • drug-drug
27
Q

Advantage of Effexor (vanlafaxine) compared to Cymbalta (Duloxetine)

A
  • less anticholinergic activity

- minimal sedation and hypotension

28
Q

Common se with Effexor

A
  • can increase BP and QTc
  • EPS, withdrawal
  • hyponatremia

GAM (27 decks)

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